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F0609
D

Failure to Immediately Report Injury of Unknown Origin

Verona, Wisconsin Survey Completed on 12-11-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that all alleged violations involving injuries of unknown source were reported immediately to the administrator and appropriate authorities, as required by facility policy and state law. On 10/27/25, two CNAs observed a large bruise on a resident's left upper arm while providing care after dinner. Despite facility policy mandating immediate reporting of such injuries to the supervisor, both CNAs did not report the bruise. The injury was not brought to the attention of supervisory staff until the following shift, when another CNA observed the bruise and reported it to an LPN, who then followed protocol. Further investigation revealed that the resident had sustained a non-displaced left humerus fracture. The facility's policy, dated 8/25, specifies that all injuries of unknown origin must be reported immediately to the Director of Nursing or Administrator, and that all allegations must be reported to the Department of Quality Assurance within specified timeframes. The Nursing Home Administrator confirmed during interview that the initial CNAs failed to report the injury as required, resulting in a delay in notification and investigation of the incident.

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